Guideline for management of sepsis and septic shock: Surviving sepsis campaign

• For adults with sepsis or septic shock, the authors suggest daily assessment for de-escalation of antimicrobials over using fixed durations of therapy without daily reassessment for de-escalation.

Duration of antibiotics

• For adults with an initial diagnosis of sepsis or septic shock and adequate source control, the authors suggest using a shorter over a longer duration of antimicrobial therapy.

Biomarkers to discontinue antibiotics

• For adults with an initial diagnosis of sepsis or septic shock and adequate source control where the optimal duration of therapy is unclear, the authors suggest using procalcitonin AND clinical evaluation to decide when to discontinue antimicrobials over clinical evaluation alone.

Fluid management

• For adults with sepsis or septic shock, the authors recommend using crystalloids as first-line fluid for resuscitation.
• For adults with sepsis or septic shock, the authors suggest using balanced crystalloids instead of normal saline for resuscitation.
• For adults with sepsis or septic shock, the authors suggest using albumin in patients who received large volumes of crystalloids over using crystalloids alone.
• For adults with sepsis or septic shock, the authors recommend against using starches for resuscitation.
• For adults with sepsis and septic shock, the authors suggest against using gelatin for resuscitation.

Vasoactive agents

• For adults with septic shock, the authors recommend using norepinephrine as the first-line agent over other vasopressors.
• For adults with septic shock on norepinephrine with inadequate MAP levels, the authors suggest adding vasopressin instead of escalating the dose of norepinephrine.
• For adults with septic shock and inadequate MAP levels despite norepinephrine and vasopressin, the authors suggest adding epinephrine.
• For adults with septic shock, the authors suggest against using terlipressin